An Interoperable, Reusable and Scalable Shared Decision Aid Navigator System: Supporting the 5 Rights of Patient Shared Decision-Making

项目摘要/摘要 为使临床决策支持有效，必须向正确的人员提供正确的信息， 正确的时间，正确的格式，通过正确的渠道(也就是‘CDS的5个权利’)。“CDS的五项权利” 该框架也适用于共享决策支持。共享决策是一种以患者为中心的形式 临床决策。患者决策辅助工具(PDA)越来越被认为是 支持共享决策，其中几个由CMS授权进行覆盖范围确定。为了方便 成功实施PDA必须将包含正确信息的PDA提供给正确的患者，地址为 在正确的时间，以正确的格式，并在正确的渠道提供。尽管已被证实的临床益处是 PDA，减少卫生系统、医生和患者在使用PDA时面临的障碍的信息学系统 都是缺乏的。PDA使用的已知限制包括必须找到正确的PDA，了解 PDA，必须离开电子健康记录(EHR)环境才能找到和使用PDA，必须 手动将数据输入PDA，并记录共享决策的过程 承担了。这项提议目标是创建一个解决已知PDA的信息学系统 实现障碍，支持“5权”框架，并被构建为可重用、可互操作和 可扩展。拟议的共享决策辅助导航系统(SDANS)将解决PDA的实施问题 限制：(1)创建支持“5权限”实现所需的PDA元数据的存储库，(2) 创建一个SMARonFHIR(SOF)EHR嵌入式PDA导航器，它依赖于PDA元数据、患者数据和 使用Fast Healthcare实施“5项权利”和支持文档的组织数据(3) 用于检索患者数据的互操作性资源(FHIR)标准，这些数据可用于支持 实施并向启用数据的PDA工具提供数据，(4)使用CQL并创建临床质量 规则(CQL)规则库，用于维护PDA实施规则，以及(5)创建管理 适用于卫生系统和实践，以修改和维护其PDA存储库和CQL 实施细则。在目标1中，我们将使用联合设计原则和患者的定性方法， 临床医生和医疗信息技术(HIT)专家设计和构建SDANS以确保其符合 那些将使用该系统的人的需求。我们还将把目前三个高质量的、循证的 CMS授权的PDA集成到SMARTonFHIR应用程序中，使我们能够测试SDANS的全部功能。 在AIM 2中，四个医疗中心将把SDAN和三个SOF转换的PDA部署到一个 概念环境，我们将评估该系统的可行性、功能性和满意度。在 长远而言，SDANS将改善个人数字助理的执行情况，并符合AHRQ的使命，改善 使用CDS，包括PDA，并改善以患者为中心的结果。

Project Summary/Abstract For clinical decision support to be effective it must provide the right information, to the right persons, at the right times, in the right formats, and via the right channels (aka ‘“The 5 Rights of CDS”). The “5 Rights of CDS” framework also applies to shared decision-making support. Shared decision-making is a patient-centered form of clinical decision-making. Patient decision aids (PDAs) are increasingly recognized as valuable tools to support shared decision making, and several are mandated by CMS for coverage determinations. To facilitate successful PDA implementation a PDA containing the right information must be provided to the right patient at the right time, in the right format, and be delivered in the right channel. Despite the proven clinical benefits of PDAs, informatics systems to reduce the barriers health systems, physicians, and patients face in using PDAs are lacking. Known limitations of PDA use include having to locate the right PDA, knowing the quality of the PDA, having to leave the electronic health record (EHR) environment to find and use the PDA, having to manually enter data into the PDA, and documenting the process of shared decision-making that was undertaken. The objective of this proposal is to create an informatics system that addresses know PDA implementation barriers, supports the “5 Rights” framework, and is built to be reusable, interoperable, and scalable. The proposed Shared Decision Aid Navigator System (SDANS) will address PDA implementation limitations by (1) creating a repository of the PDAs metadata needed to support “5 Rights” implementation, (2) creating a SMARonFHIR (SoF) EHR-embedded PDA navigator that relies on PDA metadata, patient data, and organizational data to implement the “5 Rights” and to support documentation (3) using the Fast Healthcare Interoperability Resources (FHIR) standard to retrieve patient data that can be used to support the “5 Rights” of implementation and to provide data to data-enabled PDA tools, (4) using CQL and creating a Clinical Quality Rules (CQL) rules repository to maintain PDA implementation rules, and (5) creating an administrative application for health systems and practices to modify and maintain their PDA repository and CQL implementation rules. In Aim 1 we will employ co-design principles and qualitative methods with patients, clinicians, and health information technology (HIT) experts to design and build the SDANS to ensure it meets the needs of those who will use the system. We will also convert three current high-quality, evidence-based CMS-mandated PDAs into SMARTonFHIR applications to allow us to test the full functionality of the SDANS. In Aim 2, four medical centers will deploy the SDANS and the three SOF-converted PDAs into a proof-of- concept environment and we will evaluate the feasibility, functionality and satisfaction with the system. In the long-term, the SDANS will lead to improved implementation of PDAs and meet AHRQ’s mission to improve the use of CDS, including PDAs, and to improved patient-centered outcomes.